The time from when it is known that new treatments are effective to their widespread use in United States (US) health care remains frustratingly long and may result in patients receiving suboptimal quality of care. The Institute for Healthcare Improvement (IHI) has developed a Rapid Spread Network (RSN), a multi-modal network that aims to increase the widespread adoption of effective practices. The IHI RSN has been used extensively, but has not yet been evaluated rigorously. Healthcare-associated infections are a leading cause of adverse events. In particular, surgical site infections (SSIs) occur in up to 5% of surgical patients, resulting in approximately 500,000 SSIs annually. Recent comparative effectiveness research has identified three interventions that substantially reduce SSIs: preoperative bathing or showering with chlorhexidine;preoperative nasal screening for Staphylococcus aureus carriage followed by decolonization of S. aureus carriers;and preoperative skin preparation with a long-acting antiseptic agent in combination with alcohol. These interventions can be added to the package of evidence-based SSI prevention practices previously promulgated by the Surgical Care Improvement Project (SCIP), IHI in its 100.000 Lives and 5 Million Lives Campaigns, and others, forming an "Enhanced SSI Prevention Bundle." This study will use the IHI RSN to increase adoption of the Enhanced SSI Prevention Bundle. The goal of this project is to test the hypothesis that activation of the IHI RSN will lead to increased adoption of the Enhanced SSI Prevention Bundle in arthroplastic hip and knee surgeries - a high-volume, high-cost procedures in which infection is a devastating complication. The IHI will activate the RSN in five US states and six months later in another five states. Using a cluster-randomized trial design, a group of experienced researchers from RAND and University of California, Irvine, will evaluate the effectiveness of the IHI RSN using multiple coordinated methodologies. The evaluation will provide important knowledge on whether and how the IHI RSN can accelerate widespread adoption of these new SSI prevention interventions and other new practices emerging from comparative effectiveness research to rapidly improve quality of care and reduce the risk of harm. PUBLIC HEALTH RELEVANCE: The time from when it is known that new treatments are effective to their widespread use in United States health care remains frustratingly long and may result in patients receiving suboptimal quality of care. This study assesses the effectiveness of the Institute for Healthcare Improvement Rapid Spread Network in promoting the use of three new interventions for reducing surgical site infections in hip and knee surgeries in 10 states. Success of this Rapid Spread Network will both increase use of evidence-based practices that have been shown to reduce infection rates, and provide a model for quickly spreading the adoption of other effective new treatments.